Given the chance to build a new health system from the ground up, most CIOs would do at least a few things differently. For John Kravitz, CIO at Geisinger Health System, it’s simple: “everything would be in the cloud.”
But Geisinger, a regional health system providing care to patients in 45 counties throughout Pennsylvania, is not new. It’s a 103-year-old system with three physical data centers, which means “changing our mindset is going to be very difficult.” It’s not, however, impossible. It requires a dedication to the vision that Kravitz has witnessed in full force during the past few months, as Geisinger’s IT team has surged ahead with major initiatives — including preparations to go live on Epic’s billing and lab systems — while ensuring providers are able to care for patients during a pandemic.
Recently, Kravitz spoke with healthsystemCIO about the challenges of prioritization during Covid-19, the cybersecurity concerns with going to the cloud, how deploying Microsoft Teams has improved efficiency, and how remote work is “going to change our whole methodology.”
- “Conscious decision to stay on track” with enterprise systems
- Creating queues to help manage the service desk
- “I’m very proud of my team’s resiliency.”
- Geisinger’s reopening strategy: “We’re being methodical about it.”
- “Work from Home” committee
- Deploying Teams across the organization – “It’s collaboration software.”
- Capacity planning challenges
- Anticipating a surge – “Our systems were set up.”
We made a conscious decision to stay on track with the enterprise systems, because it’s such a big part of our plan. We wanted to keep that going if at all possible.
Financially, it couldn’t come soon enough, but from a patient safety standpoint, we’re taking our time and really being methodical about it. We don’t want to have any outbreaks caused by being negligent.
It’s very much collaboration software. It’s not just the video link. It’s not just instant messaging. It’s the ability to collaborate. Everything we want to do with documentation and everything else is part of that.
We need to be this singularly focused on our strategic initiatives and not all the noise; not all the clutter that we get wrapped up in, because IT just gets nailed with so many pet projects. We have to stop those and stay focused.
Gamble: When Covid-19 first started to make an impact, what was your strategy in terms of deciding what to put on the back burner?
Kravitz: We made a conscious decision to stay on track with the enterprise systems, because it’s such a big part of our plan. We wanted to keep that going if at all possible. I think the biggest challenge was redeploying staff, even from within IT, to support the service desk. This was so important, because we had 2,000 physicians getting telemedicine training on the fly through video links, because there was no way to train them all in person. And so we created queues, one for patients trying to connect to the patient portal, and other offering support to our providers. That’s worked well.
On a daily basis, we get about 2,000 calls to the service desk; a lot of this has been exacerbated by different new technologies we’ve been deploying — we understand that, but it has worked well. So we made a conscious decision to segment the teams and have them continue on their work. And we’ve been on target. Every month when I get the project management report, we have green status. The support has been great for our employees, our staff, our physicians — everybody. We’ve been very happy with that.
And so, I think our strategy has been successful. We’ve taken some smaller projects that we didn’t think were strategically important to the organization and put them to the side. But a lot of work has been going on. I have to say, I’m very proud of my team’s resiliency, and the effort they’ve put in. They’re putting in a lot of extra hours; it’s pretty impressive.
Gamble: It’s interesting; we had heard from organizations who had clinical personnel stepping into different roles, so it’s interesting to see that with IT as well.
Kravitz: As a matter of fact, when we closed down clinics and moved toward a telemedicine model, around 5,000 or 6,000 of clinical workers were redeployed to help out in the inpatient settings, or in specific clinics that were still open and functioning. Now we’re at a point where there’s hardly anyone in the redeployment queue because things are starting to fire back up again. But it takes time. Financially, it couldn’t come soon enough, but from a patient safety standpoint, we’re taking our time and really being methodical about it. We don’t want to have any outbreaks caused by being negligent, so we’re very cautious about that.
Gamble: Right. As you ramp up for the Epic go-lives in January, will that present challenges having much of the staff work remotely?
Kravitz: I don’t think we’ll have any challenges. In fact, we’re creating a work from home committee, and I’m one of the leaders. As part of that, we’re thinking through the process and surveying both leadership and staff to get a feel for what they want to do. All of our leaders, even down to the director levels within the line staff, are meeting with them and asking, ‘What’s your preference? Do you want to work from home? Do you want to come back in the office?’ Initially, we found that about 30 percent want to permanently work remotely. We’re looking at a hybrid model as well. People may want to go back and forth, so we’ll do hoteling for offices and cubicles; we can schedule that within our Outlook system and track that appropriately.
The other thing that’s been great is we’re now using Microsoft Teams; we’re deploying it across the organization. We had previously been using Skype, but that was inside of our firewall. Everything we have with Microsoft is in the cloud, including Office 365 and the Teams version we’re on right now. It’s been working very well for us. All of IT is on that, and we’re testing it very thoroughly before we start deploying it further.
We’re trying to get Teams champions throughout the organization, because it’s very much collaboration software. It’s not just the video link. It’s not just instant messaging. It’s the ability to collaborate. Everything we want to do with documentation and everything else is part of that, data sharing and all that good stuff.
I think it’s a great opportunity for us. We are planning by the end of summer to have most of the organization moved over to Teams. It may even happen sooner if we get the Teams champions rolling quickly and get them trained, which we plan to do. We’re pretty excited about it.
Gamble: Looking back at Geisinger’s response to Covid-19, is there anything you would have done differently?
Kravitz: Because of our location — we’re primarily in Northeast Pennsylvania — we had planned for network capacity issues. For example, enabling people to work remotely during a snowstorm. Although we didn’t have any this year, we’ve had situations in the past where we’ve been down for two or three days while people dig out from the snow.
So we had planned for that, and we continued to scale upward when it was first announced back in December that there was an outbreak in China. I remember thinking, ‘there’s no way it’s going to impact us, but we need to scale up anyway.’ We did. At one point, we were able to handle about 6,000 people working from home during a weather event. We’re trying to find the right number. We said about a third of our population might have to work from home concurrently, so we scaled up to 13,000 remote users. Now, because we have Office 365 and are able to use cloud services for email and calendars, not everyone has to be inside the firewall. And so we had around 9,000 to 10,000 people concurrently using our systems, day in and day out. As we move more to a cloud environment, we’ll see even less dependence on coming into the data center and that big ramp up that we did. We can scale that back a little bit over time.
Gamble: Right. Being a system that is so spread out geographically, I imagine you had different situations in different areas, which I’m sure was challenging.
Kravitz: It was. Because Covid hit New York and New Jersey so heavily, we were expected to get slammed. And we did; our three hospital campuses located in the Wilkes Barre-Scranton area got buried with patients.
But we’re pretty spread out, like you said. We have locations in State College, Lewistown, Danville, all the way down to Harrisburg. And while Harrisburg got hit almost as hard as the northeast, the central and western regions did not, and so we used those as safety valves to move patients around as needed. It worked out fairly well, but it would have been really difficult. We were planning for a major surge, setting up zero pressure rooms and converting entire floors into med-surg areas. We were able to flick them on and off; our systems were set up for it.
Gamble: That sounds like a logistical nightmare.
Kravitz: It could have been, but it wasn’t. We deployed Epic Monitor, which allows us to monitor oxygenation levels in the blood — the critical factor in Covid-19 — for patients in med-surg or ICU beds. This allows us to track that and make sure patients get enough oxygen in their lungs.
I have to say, Epic has been excellent to work with. They actually waived implementation charges during Covid, which was phenomenal. And they did it quickly. They’ve been very good to work with, in that respect, and it’s been very much appreciated.
Gamble: When you look back at what the organization — your team — was able to do in such a short time, what are your thoughts?
Kravitz: It really shows that when you have a singular focus, you can move mountains. In discussions with our executive leadership team, I’ve said that we need to be this singularly focused on our strategic initiatives and not all the noise; not all the clutter that we get wrapped up in, because IT just gets nailed with so many pet projects. We have to stop those and stay focused. If we do that, we can move mountains. We can move quickly, and I think people are starting to see that. That’s why rationalizing 175 systems — and that’s just the first cut. I want to remove three times that amount before I’m done.
There’s a lot of stuff that we just don’t necessarily need, and we should be removing it to cleanse the organization. Interoperability is a big factor; we’re putting in an API integration platform right now too, which will help us with real-time integration. That’s really important; we’re pretty excited about that.